以晕厥为首发症状的肺栓塞一例报告

A Case Report of Pulmonary Embolism with Syncope as the First Symptom

目的提高以晕厥为首发的肺栓塞诊治的认识,并注意患者在吸氧状态下,会干扰血氧饱和度监测及血气分析结果,导致漏诊的可能。方法报告2017年11月该院收治1例以胸闷、胸痛、晕厥为主要表现的老年患者,吸氧状态下明显影响氧分压值,干扰临床医师对于病情的判断。结果患者转院至解放军总医院就诊。胸部增强CT确诊肺栓塞。经抗凝等及时有效治疗后好转。结论以晕厥为首发的肺栓塞多见于老年患者,初诊过程中由于吸氧,会影响血氧饱和度监测值及血气分析结果,造成非低氧血症假象,导致临床误诊。故对怀疑肺栓塞患者,血气分析检查前应视情况停止吸氧一段时间,以保证血气分析结果真实可靠。

Objective To improve the diagnosis and treatment of pulmonary embolism with the first syncope, and to pay attention to the patient＇s oxygen saturation state, it will interfere with blood oxygen saturation monitoring and blood gas analysis results, leading to the possibility of missed diagnosis. Methods In November 2017, an elderly patient with chest tightness, chest pain, and syncope as the main manifestation was admitted to the hospital. The oxygen partial pressure significantly affected the oxygen partial pressure value and interfered with the clinician＇s judgment on the condition. Results The patient was transferred to the General Hospital of the People＇s Liberation Army. Thoracic enhanced CT confirmed pulmonary embolism. After anti-coagulation and other timely and effective treatment, it improved. Conclusion Pulmonary embolism with syncope as the first is more common in elderly patients. In the initial diagnosis, oxygen absorption will affect the blood oxygen saturation monitoring value and blood gas analysis results, resulting in non-hypoxemia illusion, leading to clinical misdiagnosis. Therefore, for patients with suspected pulmonary embolism, blood oxygen should be stopped for a period of time before blood gas analysis to ensure that the blood gas analysis results are true and reliable.